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14040075 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10075 CRESCENT RD CONTRACTOR:TATS INC DBA MR PERMIT NO: 14040075 ROOTER PLUMBING OWNER'S NAME: STRACHMAN HOWARD L AND IRENE B 1260 YARD CT DATE ISSUED:04/11/2014 OWNER'S PHONE: 4085901777 SAN JOSE,CA 95133 PHONE NO:(408)271-2822 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑ REPLACE(E)WATER HEATER,SAME LOCATION License Class C3 G Lic.# COZY Contractor 1 G� mac, Date I� l� I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$5000 ave and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:32616069 00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS O RMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter LA LED INSPECTION. upon the above mentioned property for inspection purposes. (We)agree to save 1 indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the slued b Date: granting of this permit. Additionally,the applicant understands and will comply with all non-point u e regulations per the Cupertino Municipal Cod Secfon 918. (� RE-ROOFS: Signature Date ! ll / All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupe ino Municipal Code,Chapter 9.12 nd f h&S l HeatSafety S Code, 7az I have and will maintain Worker's Compensation Insurance,as provided for by the Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:permit is issued. I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9 18. Signature Date GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION` (�V 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228•FAX(408)777-3333•buildina(5cupertino.org `�O MISC 76"ING ❑MECHANICAL G ❑ELECTRICAL ❑MISCELLANEOUS PROSECT ADD SS �/)�f r T APN OWNERNAME PHONE J� STREET ADDRESS FAX CONTACT NAME M PHOKE NE-`MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ O)ANER-BuJLDER CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME p �� LICENSE N7loz I�1C�SE TYPE pBpUS�.LIC# COMPANY NAME MQZt � E-MAIL ES l (/� .7; �r a'W� STREET ADDRESS /f111�2-7 /1/[. Pz. crrY, J PHONE li o 04 ARCHITEC(ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF FD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND YES PROJECT IN ❑ IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL - URBAN INTERFACE AREA NO FLOOD ZONE NO EIICwHLER HOME? O DESCRIPTION OF WORK ^ �(� /�/s /�� /o e v 111 - '--- syr E�` „'"z' f Y F,r �i*`" ;vrxd. ,,, TOTAL VALUATION: RECEIVED BY � �} By my signature below,I certify to each of theto g: I the operty owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provid d i . rrect. I h e r d the Description of Work and verify it is accurate. I agree o co Iy with all applicable local ordinances and state la�vS,6lating to buildin c on. I r' representative Cupertino to enter the above-identifi prop for inspection purposes. Signature of Applicant/ eent: Date: �� SUPPLE TAL INFORMATION REQUIRED = ` ��=� OFFdGE�JSE01�7sY� •�-.�_ ; ROOM IMF Ed AVER=THECOL3�TRRgm, RE— � STA2VDAitD� ; 4 MET _ �� al RONas N MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10075 Crescent Road DATE: 04/11/2014 REVIEWED BY: Sean APN: BP#: *VALUATION: 1$5,000 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Duplex PENTAMATION PRWHEATR USE: PERMIT TYPE: i WORK Remove and Replace Water Heater. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Water Heater 1PRWHEATR 1 # $28 TOTALS: $28.00 Z$VVI Plumb.Plan Check 0.0 hrs $0.00 f='�=��. t'tu t` ecr`� Plumb.Permit Fee: IPPERAET Other Plumb Insp. 0.0 hrs $47.00 Uttter f.,"iec.Insy. -Tent I;.�,j, Te /7Jztrtit� J,�sT;. ('c•e,: t `nr Ing, T ,.e, NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These fees are based on the prelimina information available and are onLvan estimate Contact the Dept for addn'l info, FEE ITEMS (Fee Resolution 11-053 E . 7ff /1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: S2ippd. P(', /.het, PME Plan Check: $0.00 Ins]) 1"e c PME Unit Fee: $28.00 PME Permit Fee: $47.00 T77�1 Administrative Fee: 1ADMIN $44.00 Work Without Permit? ® Yes C) No $0.00 ,!dv(,,;cv d d't<uarrirIg Fees: Travel Documentation Fee: ITRAVDOC $47.00 i Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldp-Stds Commission.Fee: IBCBSC $1.00 44, TOTAL FEE: 167.50 a $167.50 $0.00 $ Revised: 04/01/2014